While the Health Act 2017 made clear the organ donation regulations, Kenya hasn’t noted an increase in donations or an expansion of infrastructure to have most surgeries done locally. Smaller family sizes, an increasingly aged population and a rigid attachment to the dead have led to an acute shortage of transplant organs in Kenya.
When Christopher Mwangala was attending a medical management course in India last year, he came across a scene that has changed his view of organ donation. Immediately following the death of an individual, Mwangala watched as health specialists descended on the body, each eager to get his “pound of flesh” literally – donated organs for potential transplants.
“One came for the kidneys, another took the heart while an eye specialist came for the cornea. There were those who came for the skin and certain bones. In India, organ donation is a very common practice accepted by citizens. It is almost a way of life,” Mwangala says.
And at that point he made up his mind to donate his cornea when he dies.
“I will not need my cornea after death while there is a long list of young people in Kenya waiting for cornea transplants. As for the rest of my body, it will depend on what my family wants to do with it after my death,” Mwangala says.
Should his resolve come to pass, he will be among the first Kenyans who commit to organ donation after his death.
And to ensure that his decision won’t be overturned by superstitious kin when that time comes, he has signed a ‘will’ to that effect.
“My wife has even countersigned my cornea donation consent documents.”
Not nearly enough donors
While many may frown at organ donation and brush off any discussion on the subject, to medical practitioners, an organ transplant may be the only option to save a life ebbing away.
“We are appealing to Kenyans to support organ harvesting from their dead,” Prof Peter Mungai of the East Africa Kidney Institute said at a symposium late last year.
Worldwide, the heart, kidneys, liver, cornea, lungs, pancreas are the most transplanted organs. Other transplants involve tissue from the skin and bones.
According to data from the World Health Organisation, over 130,000 solid organ transplants are performed worldwide annually, a paltry 10 per cent of the global need.
Close to 70,000 of these are kidney transplants with about 46 per cent obtained from living donors.
Global liver transplants amount to 20,200 annually while 5,400 heart transplants are conducted. Others are 3,400 lung transplants and 2,400 pancreas transplants.
In Kenya, the main organ transplants involve kidney and cornea. Although regular heart repairs are common, no hospital in Kenya has ever carried out any heart, liver or lung transplants due to technological constraints.
Patients who require such transplants have to travel abroad, mainly India or Europe where such procedures are routine.
According to Lions SightFirst Eye Hospital, the country has about 50,000 people suffering from corneal blindness with an annual increment of 5,000 people, mainly children.
With no substitute for human tissue, the only way such ones can regain eyesight is through a cornea transplant.
On the other hand, Kenya performs about 200 cornea transplants annually with donations mainly coming from the Shah community.
No money exchange
Contrary to popular belief, no payment should be made to a live donor for a kidney, or to one’s family for other organs like the cornea, heart, liver or lungs that are only extracted after a person’s death.
However, according to WHO, unmet patients’ needs through a shortage of transplants has led to a vibrant underground organ trafficking.
WHO estimates that the price of a renal transplant package in the black market ranges from US$ 70,000 (Sh7 million) to 160,000 (Sh16 million).
The underground organ trafficking deals are wrought with inherent dangers and may as well kill both parties.
“Transplants from kidney sellers are often performed in hospitals or clinics that are not licensed to perform transplants, and are not recognised by official medical boards. The donor may not have been properly screened, or may have not disclosed critical personal health information. some recipients may not have undergone the proper screening to ensure that it is safe for them to get a kidney transplant,” states the study.
In Kenya, the Health Act 2017 states that removal of organs from either a living or dead person can only be done in authorised health facility without charge.
“Anyone who charges a fee for a human organ is liable on conviction to a fine not exceeding Sh 10 M or to imprisonment for a period not exceeding 10 years or both,” it states.
Professor Mungai Ngugi, a urologist and director of the East Africa Kidney Institute, says key requirements for kidney donors are that they be in good health and able to physically withstand the rigours of life with one kidney.
“Donations can only come from willing Kenyans. A donated kidney must also match with the patient. Kidneys cannot be imported since they cannot be kept for long after extraction,” he says.
While an organ is given without charge, there are cost implications for the procedures especially within private health facilities.
“The cost of the operation for the donor and recipient of a kidney may be as much as Sh3 million. Of these, the doctor’s fees in private practice may be about Sh60,000. However, the operation is done freely at Kenyatta National Hospital and Moi Teaching and Referral Hospital,” says Ngugi.
Dr Maruthi Halappa, a consultant ophthalmologist and cornea specialist at The Lions SightFirst Eye Hospital says anybody, including those who are 70 years old, can donate a cornea.
“Those older than 70 can donate if they have no prior eye surgeries. However, the older one is, the less cell count there will be in the donated organ. Therefore, it is not possible to transplant a cornea from an 80-year-old to a ten-year-old,” he says.
In addition, cornea of one who suffered from HIV and Aids or Hepatitis is not used in transplants.
According to the eye hospital, only the cornea is transplanted, not the whole eye ball. The cornea must also be harvested six to eight hours after death and frozen immediately to avoid decomposition.
Still, WHO states that with all transplanted material, there may be may ethical and safety risks. These include the risks of disease transmission from the transplants. There are also cases where the transplant is rejected by the recipient’s body.
In addition, some transplants may involve blood transfusions and associated complications.